Numbers have gone up - any advice much appreciated

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lauren77

lauren77

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Hi Everyone -

Any advice from the seasoned experts re numbers going up would be much appreciated. I took Ozzie for his retest at the vet's this morning and his BG was 389. The vet wanted to up the dose of lantus to 2 units but then said okay if you're comfortable at judging 1.50 on the syringe to try that. I tested him three times and it was 318/327/356 on three different days and the last one was 356 which was his dx number last Monday morning - so it seemed we went full circle in 7 days and ended up back at the number he had started at on the day of his DX. He today tested 389 taking blood from the leg. I had switched to DM, cut out all dry and bought the FF cans of low carbs. The only thing and I told the vet was that I am giving little plates of food b/c he seems hungry. He said he will be b/c of the diabetes that will subside once that is under control. So I'm now back to DM wet food morning/evening with little teaspoons of FF food (low carb varieties) and starting at 1.5 units this evening. His little ears are still bruised from my first two attempts at getting blood the third was painless but still left bruising. He is all white and you can clearly see his veins. They recommended Neosporin to bead and to warm up the ears really well to prevent the bruising. Poor fella, I just do not know what to do to get this right. Am I on the right track w/ increasing the dosage and DM twice a day, teaspoons of FF throughout the day to supplement his main meals?
Many thanks for your help thus far ---
 
No help with the Lantus, never used it, but the bruising of the ear will ease up as the ear toughens up. I've been testing one of mine, Mishka, for 7 years, and I still will get a little bruising sometimes but it disappears. Just make sure to always apply a little pressure from both sides of the ear after testing......stops the blood and helps bruising. I have never used Neosporin on the ear...vaseline is usually what is used to bead the blood. I've never used anything on any ears in all the years I have been testing.
 
Hi there

Am I right in interpreting this as saying you've had difficulties testing and have 3 results from random times during the past week? If so, you are comparing apples to orranges so to speak, ie if they aren't all at the same time of day then you cannot compare.

Second, there is a chance that stress MAY inflate blood glucose values if tested at the vet clinic, so I wouldn't base your decisions on that one test.

What you need to know is consistent information on preshot and nadir (lowest point) values for a period of time, remembering that it takes time for the 'shed' thingy to work (I am not a lantus user) plus you've also added in a food change. Add in the fact that meters have an accuracy of +/- 20% and things really haven't gotten worse.

Does this make any sense?

Jen
 
Thank you, Hope and Jen. I know that is what the vet said apples and oranges kind of. It has to be tested at the same time each day and I will do that. He was tested at 10.40 this morning so on Thursday I have to test and call the vet with the number - I'm hoping the increase in dosage will work but who knows b/c I cannot get my head around that we went all week and ended up back where we started. Re his ears, the vet noticed immediately, I had to explain about the bruising and how crap I was on the first two tests. Thanx again, I'll study more and research if someone else has suffered this set back so soon!
 
But you shouldn't be looking at it as a setback. Treating feline diabetes takes patience and time and lots of reading (and chocolate and beverage of choice). If you expect immediate results you may be disappointed and act hastily.

Jen
 
With Lantus, your dose needs to be based on the nadir.
How to do a Curve
Example of a typical curve:
+0 - PreShot number.
+1 – Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 – Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number.


One number will not really tell you much, so if you can test before each shot, and then again someplace in the middle of the cycle, you will start to see a better picture.

Here is some info on Lantus that may help you:
Tight Regulation Protocol
LANTUS & LEVEMIR – INSULIN DEPOT –AKA- STORAGE SHED
Lantus&Levemir – Data Ready to Shoot Low Numbers

Lantus likes consistency; jumping around in dose does now work well with Lantus. Also, sticking to shots every 12hours is important.

A bit of the guidelines that will help you with dosing:
"General" Guidelines:

--- Hold the initial starting dose for 5 - 7 days (10 - 14 cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 cycles).

--- Each subsequent dose is held for a minimum of 3 days (6 cycles) unless kitty earns a reduction (See: Reducing the dose...).

--- Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.


Increasing the dose...
--- Hold the dose for 3 - 5 days (6 - 10 cycles) if nadirs are less than 200 before increasing the dose.

--- After 3 consecutive days (6 cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.

--- After 3 consecutive days (6 cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.


Reducing the dose...
--- If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

--- If an attempted reduction fails, go right back up to the last good dose.

--- Try to go from 0.25u to 0.1u before stopping insulin completely.


Random Notes...
Because of the cumulative nature of Lantus and Levemir:
An early shot = a dose increase.
A late shot = a dose reduction.

A "cycle" refers to the period of time between shots. There are 2 cycles in one day when shooting twice a day.

Sometimes a dose will need to be "fine tuned" by adding some "fat" or "skinny-ing up" the dose.
 
Thanx Gayle & Jen -

I will keep looking and reading - looked through a myraid of info last night online but I have to keep coming back here to see first hand what the reality is with the various hands-on owners. I looked at the various spreadsheets and it's amazing how different all everybody's cats are reacting.
 
sooo....in conclusion, chill baby :-D You are at week one, and you aren't going to figure it all out and solve it in a week!
 
May I ssuggest to go on over to the Insulin Support Groups / Lantus. Read all the stickies and then ask questions... set up your own spreadsheet - LOT of expertise there on Lantus..! You'll be in the best of hands...
 
Lauren,

Have we mentioned the neosporin for his ears? You can use the kind with or without pain reliever.

Agree with Perry that the insulin specific advice on the Lantus Support group would be helpful to you.
 
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